Risk factors associated with hospital admission in COVID-19 patients initially admitted to an observation unit
No set guidelines to guide disposition decisions from the emergency department (ED) in patients with COVID-19 exist. Our goal was to determine characteristics that identify patients at high risk for adverse outcomes who may need admission to the hospital instead of an observation unit. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - October 8, 2020 Category: Emergency Medicine Authors: Frances M. Russell, Alfred Wang, Robert R. Ehrman, Jake Jacobs, Alex Croft, Caleb Larsen Source Type: research

Implementation of musculoskeletal specialists in the emergency department at a level A1 VA Hospital during the SARS-CoV-2 pandemic
A 2017 systematic review and meta-analysis demonstrated the unwavering recurrence of low back pain (LBP) presentation in emergency departments (ED) [1]. In early 2020, the SARS-CoV-2 pandemic depleted resources as ED providers tended to COVID-19 patients. Simultaneously, pain management routine care was deemed “non-essential.”† These unattended pain complaints were likely to present to the overburdened ED. LBP in the ED has become increasingly common and challenging to manage [2]. Efficiently triaging non-emergent LBP may redirect and improve ED service utilization. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - October 8, 2020 Category: Emergency Medicine Authors: Alec L. Schielke, Annie R. Babikian, Robert W. Walsh, Priya Rajagopal Source Type: research

Association between patient-physician gender concordance and patient experience scores. Is there gender bias?
Patient satisfaction, a commonly measured indicator of quality of care and patient experience, is often used in physician performance reviews and promotion decisions. Patient satisfaction surveys may introduce gender-related bias. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - October 8, 2020 Category: Emergency Medicine Authors: Sharon Chekijian, Jeremiah Kinsman, R. Andrew Taylor, Shashank Ravi, Vivek Parwani, Andrew Ulrich, Arjun Venkatesh, Pooja Agrawal Source Type: research

The prehospital SIGARC score to assess septic shock in-hospital, 30-day and 90-day mortality
We report the association between the new SIGARC score and in-hospital, 30 and 90-day mortality of SS patients cared for in the pre-hospital setting by a mobile ICU (MICU). (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - October 8, 2020 Category: Emergency Medicine Authors: Romain Jouffroy, Basile Gilbert, Jean Pierre Tourtier, Emmanuel Bloch-Laine, Patrick Ecollan, Vincent Bounes, Josiane Boularan, Papa Gueye-Ngalgou, Beno ît Vivien Source Type: research

No evidence of increasing COVID-19 in health care workers after implementation of high flow nasal cannula: A safety evaluation
Initial recommendations discouraged high flow nasal cannula (HFNC) in COVID-19 patients, driven by concern for healthcare worker (HCW) exposure. Noting high morbidity and mortality from early invasive mechanical ventilation, we implemented a COVID-19 respiratory protocol employing HFNC in severe COVID-19 and HCW exposed to COVID-19 patients on HFNC wore N95/KN95 masks. Utilization of HFNC increased significantly but questions remained regarding HCW infection rate. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - October 6, 2020 Category: Emergency Medicine Authors: Lauren M. Westafer, William E. Soares, Doug Salvador, Venkatrao Medarametla, Elizabeth M. Schoenfeld Source Type: research

The effect of the severity COVID-19 infection on electrocardiography
Acute myocardial damage is detected in a significant portion of patients with coronavirus 2019 disease (COVID-19) infection, with a reported prevalence of 7 –28%. The aim of this study was to investigate the relationship between electrocardiographic findings and the indicators of the severity of COVID-19 detected on electrocardiography (ECG). (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - October 6, 2020 Category: Emergency Medicine Authors: Hasan Ali Barman, M.D. Adem Atici, M.D. Gokhan Alici, M.D. Omer Sit, M.D. Sevil Tugrul, M.D. Baris Gungor, M.D. Ertugrul Okuyan, M.D. Irfan Sahin Source Type: research

Young children with psychiatric complaints in the pediatric emergency department
Children are increasingly diagnosed with mental illnesses and self-harm behaviors. They present frequently to the emergency department (ED) for evaluation. The aim of this study is to describe the youngest children in the ED with psychiatric issues. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - October 6, 2020 Category: Emergency Medicine Authors: Melanie M. Randall, Karli Parlette, Ellen Reibling, Brian Chen, Miryah Chen, Frank Randall, Lance Brown Source Type: research

Acute renal failure with severe loin pain and patchy renal ischemia after anaerobic exercise: A case series
Acute renal failure with severe loin pain and patchy renal ischemia after anaerobic exercise (ALPE) is gradually gaining recognition. In this case series, we describe the presentation of ALPE in the emergency department setting and its clinical course. In Case 1, an 18-year-old man presented with acute-onset nausea, vomiting, and right flank pain after playing basketball, with a creatinine level of 6.42  mg/dL on initial presentation. He received fluid therapy and intravenous furosemide for 2 days. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - October 6, 2020 Category: Emergency Medicine Authors: Miyuki Shoho, Akira Kuriyama Source Type: research

Use of the BIG score to predict mortality in pediatric trauma
The BIG score, which is comprised of admission base deficit (B), International Normalized Ratio (I), and GCS (G), is a severity of illness score that can be used to rapidly predict in-hospital mortality in pediatric patients presenting following traumatic injury. We sought to compare the mortality prediction of the pediatric trauma BIG score with other well-established pediatric trauma severity of illness scores: the pediatric logistic organ dysfunction (PELOD); the pediatric index of mortality 2 (PIM2); and the pediatric risk of mortality (PRISM III). (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - October 4, 2020 Category: Emergency Medicine Authors: Jeff Bolstridge, Erika R. O'Neil, James K. Aden, Teddy Muisyo, Philip C. Spinella, Matthew A. Borgman Source Type: research

Nucleated red blood cells as predictor of all-cause mortality in emergency department
In this study, we aimed to investigate whether NRBCs predict for all causes of death in patients admitted to the emergency department (ED). (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - October 4, 2020 Category: Emergency Medicine Authors: H üseyin Narcı, Mehmet Murat Oktay, Cüneyt Ayrık, Mehmet Burak Yavuz Çimen Source Type: research

HIV post-exposure prophylaxis in the emergency department: An updated assessment and opportunities for HIV prevention identified
This study is an assessment of ED prescribers' knowledge, attitudes and practices regarding administration of HIV nPEP. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - October 4, 2020 Category: Emergency Medicine Authors: Katie A. O'Connell, Alice V. Kisteneff, Shanedeep S. Gill, Joshua F. Edwards, William W. Sherrerd-Smith, Laila A. Moraczewski, Catherine J. Derber, Bruce M. Lo Source Type: research

The role of the serum lactate level at the first admission to the emergency department in predicting mortality
Lactate is an easily measurable laboratory parameter that is considered a potentially useful prognostic marker for determining risk in emergency room patients. The aim of this study was to investigate the role of serum lactate in the patients who were admitted to the emergency department at the time of admission. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - October 3, 2020 Category: Emergency Medicine Authors: Yurdagul Cetin Seker, Oner Bozan, Emel Sam, Hakan Topacoglu, Asim Kalkan Source Type: research

Interhospital transportation of a COVID-19 patient undergoing veno-venous extracorporeal membrane oxygenation by helicopter
Some coronavirus disease 2019 (COVID-19) patients develop rapidly progressive acute respiratory distress syndrome and require veno-venous extracorporeal membrane oxygenation (VV ECMO). A previous study recommended the transfer of ECMO patients to ECMO centers. However, because of the pandemic, a limited number of ECMO centers are available for patient transfer. The safe long-distance interhospital transport of these patients is a concern. To minimize transportation time, helicopter use is a suitable choice. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - October 2, 2020 Category: Emergency Medicine Authors: Taro Imaeda, Noriyuki Hattori, Ryuzo Abe, Shinya Iwase, Daiki Saito, Kazuhisa Koizumi, Wansiri Chaisirin, Toshibumi Taniguchi, Taka-aki Nakada Tags: Case Report Source Type: research

Evaluation of the blood pressure effects of diltiazem versus metoprolol in the acute treatment of atrial fibrillation with rapid ventricular rate
Purpose: To evaluate the difference in blood pressure effects of diltiazem intravenous push (IVP) and metoprolol IVP in the acute management of atrial fibrillation with rapid ventricular rate (AF with RVR). Methods: This was a single-center, retrospective cohort study evaluating patients who presented to the emergency department (ED) between January 2012 and September 2018 in AF with RVR and received either diltiazem IVP or metoprolol IVP as the first agent for rate control. The primary objective was the change in systolic blood pressure (SBP) within one hour of initial medication administration. (Source: The American Jour...
Source: The American Journal of Emergency Medicine - October 2, 2020 Category: Emergency Medicine Authors: Stephany Nu ñez Cruz, Joshua M. DeMott, Gary D. Peksa, Giles Slocum Source Type: research

Comment on: “Neutrophil to lymphocyte ratio is associated with in-hospital mortality in older adults admitted to the emergency department
We have read the article by Song et al. [1], entitled “Neutrophil to lymphocyte ratio is associated with in-hospital mortality in older adults admitted to the emergency department” with great interest. The authors emphasized that the NLR (Neutrophil to lymphocyte ratio) at admission is associated with in-hospital death for patients older than 65  years, and that the NLR at admission may represent a surrogate marker for disease severity. First of all, We congratulate the authors for their invaluable contribution to the literature. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - October 1, 2020 Category: Emergency Medicine Authors: Cihan Bedel, Mustafa Korkut Source Type: research

Editorial Board
(Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - October 1, 2020 Category: Emergency Medicine Source Type: research

Toc
(Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - October 1, 2020 Category: Emergency Medicine Source Type: research

Info for authors
(Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - October 1, 2020 Category: Emergency Medicine Source Type: research

Response to case comparisons and a new definition of disease-free status
In this commentary, the authors juxtapose two recently published case reports of possible COVID-19 reinfection, and in doing so make an important point about approaches to differentiate true COVID-19 reinfection from prolonged viral shedding. They use a case report to highlight the utility of whole genome sequencing and biomarkers such as C-reactive protein (CRP) to identify cases of true reinfection. This is an important topic as debate surrounding the possibility of COVID-19 reinfection is at the forefront of conversations about limiting global disease spread. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - September 30, 2020 Category: Emergency Medicine Authors: Nicole M. Duggan, Susan R. Wilcox Source Type: research

High Flow Nasal Cannula is superior than CPAP in carbon monoxide poisoning
To the Editor, (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - September 30, 2020 Category: Emergency Medicine Authors: K ıvanç Karaman, Yalcin Golcuk, Birdal Yıldırım, Ethem Acar Source Type: research

CPAP versus HFNC use in carbon monoxide poisoning
To the editor; (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - September 30, 2020 Category: Emergency Medicine Authors: Kas ım Turgut, Erdal Yavuz Source Type: research

Inhaled budesonide does not prevent acute mountain sickness?
We read with great interest the excellent article titled “Inhaled budesonide for the prevention of acute mountain sickness: A meta-analysis of randomized controlled trials” by Zhu and colleagues [1]. The authors should be complimented on their efforts to address the importance of budesonide in acute mountain sickness (AMS). In the current meta-analysi s, the authors concluded that the inhaled budesonide is effective in reducing heart rate and increasing pulse oxygen saturation, but does not protect against AMS. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - September 30, 2020 Category: Emergency Medicine Authors: Huai-Kuan Huang, Chun-Yu Chang, Meng-Yu Wu Source Type: research

Thrombotic complications of COVID-19
The novel coronavirus disease of 2019 (COVID-19) is associated with significant morbidity and mortality. The impact of thrombotic complications has been increasingly recognized as an important component of this disease. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - September 30, 2020 Category: Emergency Medicine Authors: Jacob Avila, Brit Long, Dallas Holladay, Michael Gottlieb Source Type: research

Clinical validation demonstrates concordance of qSOFA and POC lactate Bayesian model: Results from the ACDC Phase-2 program
The objective of this study was to validate a Bayesian Model that integrates qSOFA and prehospital Lactate, with a comparison analysis from a real clinical data of patients with sepsis. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - September 30, 2020 Category: Emergency Medicine Authors: Amado Alejandro B áez, Oscar López, María del P. Martínez, Nicole Libell, Laila Cochón, José María Nicolás Source Type: research

Effectiveness of negative pressure isolation stretcher and rooms for SARS-CoV-2 nosocomial infection control and maintenance of South Korean emergency department capacity
This study evaluated the effectiveness of the negative pressure isolation stretcher (NPIS) and additional negative pressure isolation rooms (NPIRs) on the maintenance of emergency care capacity during the COVID-19 outbreak. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - September 30, 2020 Category: Emergency Medicine Authors: Sang-Chul Kim, So Yeon Kong, Gwan-Jin Park, Ji-Han Lee, Joon-Kee Lee, Moo-Seop Lee, Heon Seok Han Source Type: research

Cheiro-Oral syndrome
The Cheiro-Oral (COS) Syndrome is a rare neurologic condition characterized by sensory disturbances involving the peri-oral area and the upper extremity, typically isolated to the hand or fingers. The thalamus contralateral to the symptomatic side is the brain region most commonly involved. Most cases are caused by ischemic or hemorrhagic strokes, although other structural lesions have been implicated. These include tumors, subdural hematomas, aneurysms, and infections. The unusual and seemingly unrelated nature of the symptoms may contribute to misdiagnosis and incomplete workup for potentially serious conditions. (Source...
Source: The American Journal of Emergency Medicine - September 30, 2020 Category: Emergency Medicine Authors: Sara Manning, Brent R. King, John Peffer, Dylan Lescure Source Type: research

Cheiro-Oral syndrome: A report of two cases and review
The Cheiro-Oral (COS) Syndrome is a rare neurologic condition characterized by sensory disturbances involving the peri-oral area and the upper extremity, typically isolated to the hand or fingers. The thalamus contralateral to the symptomatic side is the brain region most commonly involved. Most cases are caused by ischemic or hemorrhagic strokes, although other structural lesions have been implicated. These include tumors, subdural hematomas, aneurysms, and infections. The unusual and seemingly unrelated nature of the symptoms may contribute to misdiagnosis and incomplete workup for potentially serious conditions. (Source...
Source: The American Journal of Emergency Medicine - September 29, 2020 Category: Emergency Medicine Authors: Sara Manning, Brent R. King, John Peffer, Dylan Lescure Source Type: research

The role of the quick sequential organ failure assessment score (qSOFA) and modified early warning score (MEWS) in the pre-hospitalization prediction of sepsis prognosis
In this study, we aimed to assess the use of the quick sequential organ failure assessment score (qSOFA) and modified early warning score (MEWS) scoring systems in emergency health care services for sepsis to predict intensive care hospitalization and 28-day mortality. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - September 29, 2020 Category: Emergency Medicine Authors: Eren Usul, Semih Korkut, Af şin Emre Kayıpmaz, Ali Halıcı, Cemil Kavalcı Source Type: research

An attempt at administering a transdermal formulation of bisoprolol in patients with acute cardiac symptoms
Bisono ® is the world's first transdermal formulation of a bisoprolol, which is approved for the treatment of hypertension in Japan. We aimed to investigate the usefulness of this formulation in patients who were admitted to our hospital with cardiac symptoms suggestive of acute coronary syndrome or an ac ute exacerbation of heart failure. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - September 29, 2020 Category: Emergency Medicine Authors: Ayumu Nozaki, Tomoko Kobayashi, Kazumasa Naruhashi, Hiroshi Okugawa, Nozomu Horiuchi, Hirokazu Nakanishi, Yuka Kobayashi, Shigeru Nakamura Source Type: research

Impact of personal protective equipment on the effectiveness of chest compression - A systematic review and meta-analysis
To assess the impact of personal protective equipment (PPE) on different aspects of chest compression (CC) during cardiopulmonary resuscitation, we conducted this study. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - September 29, 2020 Category: Emergency Medicine Authors: Ankit Kumar Sahu, Soorya Suresh, Roshan Mathew, Praveen Aggarwal, Jamshed Nayer Source Type: research

Decompensated hypothyroidism: A review for the emergency clinician
Decompensated hypothyroidism, formerly known as myxedema coma, is an endocrine emergency that commonly presents with altered mental status, as well as hypothermia and depressed vital signs. The condition is often caused by an inciting event, which may lead to significant delays in the diagnosis and management of this disease. Although the incidence is low, this disease is associated with significant morbidity and mortality. Therefore, it is important for emergency clinicians to be aware of this condition. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - September 29, 2020 Category: Emergency Medicine Authors: Rachel E. Bridwell, George C. Willis, Michael Gottlieb, Alex Koyfman, Brit Long Source Type: research

Cherio-Oral syndrome: A report of two cases and review
The Cheiro-Oral (COS) Syndrome is a rare neurologic condition characterized by sensory disturbances involving the peri-oral area and the upper extremity, typically isolated to the hand or fingers. The thalamus contralateral to the symptomatic side is the brain region most commonly involved. Most cases are caused by ischemic or hemorrhagic strokes, although other structural lesions have been implicated. These include tumors, subdural hematomas, aneurysms, and infections. The unusual and seemingly unrelated nature of the symptoms may contribute to misdiagnosis and incomplete workup for potentially serious conditions. (Source...
Source: The American Journal of Emergency Medicine - September 29, 2020 Category: Emergency Medicine Authors: Sara Manning, Brent R. King, John Peffer, Dylan Lescure Source Type: research

A case of extrapleural hematoma that was not detectable on initial CT in a patient with pneumonia
Extrapleural hematoma (EH) is an uncommon and occasionally life-threatening condition. Huge EH can cause potentially fatal respiratory and circulatory disturbances. The usual causes of EH are chest trauma, iatrogenic injury, and rupture of a thoracic aortic aneurysm. There have been few reports of EH as a complication of pneumonia. Here we describe a case of EH that was not detectable on initial computed tomography (CT) in a patient with pneumonia despite symptoms suggestive of hemorrhage. A 70- year-old man who had been diagnosed with pneumonia the previous day visited our hospital after developing right upper abdominal p...
Source: The American Journal of Emergency Medicine - September 29, 2020 Category: Emergency Medicine Authors: Iwasaki Tsutomu, Yuri Kunitani, Hiraku Funakoshi Source Type: research

Noninvasive ventilation for acute hypoxemic respiratory failure in patients with COVID-19
Noninvasive ventilation (NIV) is known to reduce intubation in patients with acute hypoxemic respiratory failure (AHRF) [1]. We aimed to assess the outcomes of NIV application in COVID-19 patients with AHRF. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - September 29, 2020 Category: Emergency Medicine Authors: Sergey N. Avdeev, Andrey I. Yaroshetskiy, Natalia A. Tsareva, Zamira M. Merzhoeva, Natalia V. Trushenko, Galina V. Nekludova, Svetlana Yu Chikina Source Type: research

Acute toxicity associated with cannabis edibles following decriminalization of marijuana in Michigan
The state law to legalize recreational use of marijuana in Michigan went into effect in December 2018. Increased availability and use of cannabis in Michigan have led to an increase in emergency department (ED) visits associated with all forms of the drug. The purpose of this report is to describe the clinical effects and toxicity associated with ingestion of food products containing delta-9-tetrahydrocannabinol (THC), during the early legalization period of recreational cannabis in Michigan. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - September 29, 2020 Category: Emergency Medicine Authors: Brian Lewis, Tiffany Fleeger, Bryan Judge, Brad Riley, J.S. Jones Source Type: research

SARS-CoV-2 infection and its association with thrombosis and ischemic stroke: a review
This review of current literature provides background to the COVID-19 pandemic, as well as an examination of potential pathophysiologic mechanisms behind development of thrombosis and ischemic stroke related to COVID-19. SARS-CoV-2 infection is well-documented to cause severe pneumonia, however, thrombosis and thrombotic complications, such as ischemic stroke, have also been documented in a variety of patient demographics. SARS-CoV-2 infection is known to cause a significant inflammatory response, as well as invasion of vascular endothelial cells, resulting in endothelial dysfunction. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - September 28, 2020 Category: Emergency Medicine Authors: Jonathan Snell Source Type: research

Antibiotic prescribing patterns for adult urinary tract infections within emergency department and urgent care settings
Urinary tract infections (UTI) are a common reason for emergency department (ED) and urgent care (UC) visits. Fluoroquinolones (FQ) are frequently prescribed for treatment of UTI in the outpatient setting; however, data evaluating prescribing patterns after FDA safety warnings is limited, especially in UC. The study goal was to investigate and compare antimicrobial prescribing for UTIs in a single-site ED and an off-site UC in an urban, academic health system. This retrospective study included patients presenting with a UTI to the ED or UC between January and June 2018.Those 18  years or older with uncomplicated, complic...
Source: The American Journal of Emergency Medicine - September 28, 2020 Category: Emergency Medicine Authors: Navya Maddali, Amanda Cantin, Sanjana Koshy, Erick Eiting, Marianna Fedorenko Source Type: research

Disimpaction induced NSTEMI: A case report
Constipation is a common complaint in the Emergency Department (ED), especially amongst the elderly [1]. Patients presenting with fecal impaction (FI) are of special concern given the risk of complications including infection, systemic inflammatory response, cardiopulmonary collapse, and death [2-4]. For these reasons and to alleviate discomfort, therapeutic disimpaction is performed in the ED [5]. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - September 28, 2020 Category: Emergency Medicine Authors: Daniel L. Golden, Zachary S. Freedman, Christopher L. Hennessy, R. Wright, Anne R. Katz Source Type: research

SARS-CoV-2 infection and its association with thrombosis and ischemic stroke: A review COVID-19, thrombosis, and ischemic stroke
This review of current literature provides background to the COVID-19 pandemic, as well as an examination of potential pathophysiologic mechanisms behind development of thrombosis and ischemic stroke related to COVID-19. SARS-CoV-2 infection is well-documented to cause severe pneumonia, however, thrombosis and thrombotic complications, such as ischemic stroke, have also been documented in a variety of patient demographics. SARS-CoV-2 infection is known to cause a significant inflammatory response, as well as invasion of vascular endothelial cells, resulting in endothelial dysfunction. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - September 28, 2020 Category: Emergency Medicine Authors: Jonathan Snell Source Type: research

Malperfusion-associated transient monoplegia as an initial manifestation of aortic dissection
Acute aortic dissection (AD) is a life-threatening emergency. The most common symptom of AD is chest pain, more frequently associated with Type-A AD per the Stanford classification, while Type-B AD is associated with back and abdominal pain. Conversely, monoplegia is an uncommon symptom of AD. We encountered a case of transient monoplegia caused by Stanford type-B AD. A 75-year-old man presented with acute-onset lumbar back pain with monoplegia. Lumbar radiography revealed multiple compression fractures and spinal-canal stenosis, and accordingly acute spinal-cord compression was suspected. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - September 28, 2020 Category: Emergency Medicine Authors: Yuhei Uriu, Akira Kuriyama Source Type: research

Upper airway obstruction and hemorrhagic shock due to ruptured aneurysms in a patient with neurofibromatosis type 1
Neurofibromatosis type 1 (NF-1; von Recklinghausen disease) is an autosomal dominant genetic disorder characterized by multiple caf é-au-lait macules and neurofibromas [1]. Malignant neoplastic complications are common causes of death in NF-1 patients. Vascular complications are very rare but can lead to life-threatening hemorrhage if they occur [2,3]. Among the various vascular complications, there have been only a few case re ports of NF-1 patients with ruptures of artery aneurysms in the neck region that compromised upper airway [4,5]. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - September 28, 2020 Category: Emergency Medicine Authors: Hiromi Ihoriya, Keisuke Maeda, Toshihisa Ichiba, Fumiya Inoue, Hiroshi Naitou Source Type: research

Cholesterol embolization and arterial occlusion from the Heimlich maneuver: A case report
We present the case of the 56-year-old female presenting to the emergency department with acute right foot pain following performance of the Heimlich maneuver who was found to have distal arterial occlusion resulting from cholesterol embolization syndrome. The patient underwent right popliteal artery exploration, right popliteal and tibial thrombectomy, and popliteal patch angioplasty resulting in restoration of blood flow to her right foot. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - September 28, 2020 Category: Emergency Medicine Authors: Alec J. Pawlukiewicz, Daniel R. Merrill, Sean A. Griffiths, Garrett Frantz, Rachel E. Bridwell Source Type: research

A useful case for comparison, and a new definition of disease-free status
The recent report of corona virus 2019 reinfection [1] has some parallels with, and also some differences from another recently published report of covid 19 reinfection [2]. The latter report concerned a 33  year old man who initially presented with fever. Cough, sputum, sore throat and headache. The diagnosis of covid-19 was confirmed by a positive posterior oropharyngeal saliva SARS-Cov-2 RT-PCR test on March 26, 2020. By the time he was hospitalised, on March 29, all his symptoms had subsided. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - September 28, 2020 Category: Emergency Medicine Authors: Oscar M.P. Jolobe Source Type: research

The gap of knowledge and skill – One reason for unsuccessful management of mass casualty incidents and disasters
Despite several reports confirming the requirements for a successful management of disasters and major incidents (MIDs), the available literature indicates vulnerabilities in both structural and non-structural parts of healthcare systems [1-2]. The former includes the need for alternative medical facilities, and related critical infrastructure and the latter presence of qualified staff [3-4]. Effective preparedness to respond to any emergency requires a well-planned and integrated effort by all personnel, who, equipped with the needed expertise and skills, can deal with crisis. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - September 28, 2020 Category: Emergency Medicine Authors: Krzysztof Goniewicz, Frederick M. Burkle, Amir Khorram-Manesh Source Type: research

What we learned from the 2019 –2020 Australian Bushfire disaster: Making counter-terrorism medicine a strategic preparedness priority
With over 46 million acres burnt, 5900 buildings destroyed, and over $100 billion in damage and economic costs, the Australian bushfire season of 2019 –2020, also dubbed the “Black Summer”, is estimated to be the costliest natural disaster in the country to date, and put an unprecedented strain on response systems. [1] In light of the strain caused by the concurrent global COVID-19 pandemic, the uniquely vulnerable Australian healthcare syst em is highly susceptible to strategic, asymmetrical terrorist attack, which has been threatened by some radical extremist organizations. (Source: The American Journal...
Source: The American Journal of Emergency Medicine - September 28, 2020 Category: Emergency Medicine Authors: Derrick Tin, Attila J. Hertelendy, Gregory R. Ciottone Source Type: research

Emergency department screening for multisystem inflammatory syndrome (MIS-C) in children
Multisystem inflammatory syndrome in children (MIS-C) was defined by the Centers for Disease Control and Prevention (CDC) in May 2020 [1]. An approach to the identification of this uncommon yet life-threatening illness among well-appearing febrile children presenting for medical care is urgently needed as the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection continuous to affect millions worldwide [2,3]. Thus, the aims of this report are to: (1) describe our institutional approach to screening for MIS-C; (2) report the test characteristics of our approach in excluding MIS-C; and (3) provide recommendat...
Source: The American Journal of Emergency Medicine - September 28, 2020 Category: Emergency Medicine Authors: Amy M. DeLaroche, Curt Stankovic, Robert R. Ehrman, M.S. Jennifer Noble, Rajan Arora, Karolina Maksimowski, Ronald Ruffing Source Type: research

Cardiac and extracardiac side effects of eye drops
Apart from causing symptomatic bradycardia attributable to 2:1 atrioventricular block, the latter exemplified by the 89-rear old patient who experienced a reaction to timolol [1], ocular instillation of this beta-blocker can also cause complete heart block and a variety of other bradyarrhythmias [2]. Timolol eye drops can also cause both bradycardia and postural hypotension [3]. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - September 27, 2020 Category: Emergency Medicine Authors: Oscar M.P. Jolobe Source Type: research

The critical care literature 2019
An emergency physician (EP) is often the first health care provider to evaluate, resuscitate, and manage a critically ill patient. In recent years, the annual hours of critical care delivered in emergency departments across the United States has steadily increased. From 2006 to 2014, emergency department (ED) visits for critically ill patients increased approximately 80%. In addition to seeing more critically ill patients, EPs are often tasked with providing critical care long beyond the initial resuscitation period. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - September 27, 2020 Category: Emergency Medicine Authors: Michael E. Winters, Kami Hu, Joseph P. Martinez, Haney Mallemat, William J. Brady Tags: Reviews Source Type: research

Relevance of frailty and functional limitations in elderly patients treated with noninvasive ventilation in the ED
Exacerbations of chronic obstructive pulmonary disease and heart failure are highly prevalent among older patients [1], and, together with pneumonia, are among the leading causes of acute respiratory failure (ARF) requiring urgent medical care and noninvasive ventilation (NIV). In clinical practice, age and pathophysiological parameters are usually taken into account for outcome prediction [2]. Still, this approach could not be satisfactory in older patients whose prognosis might better be evaluated through a more comprehensive one [3], including formal evaluation of frailty and functional autonomy. (Source: The American J...
Source: The American Journal of Emergency Medicine - September 27, 2020 Category: Emergency Medicine Authors: P.L. Balzaretti, M.L. Aurucci, P. Frattoni, A. Reano, D. Vallino, M. Durazzo, M. Bo Source Type: research

Pediatric emergency department volumes and throughput during the COVID-19 pandemic
Patient volumes in our pediatric emergency department (PED) decreased significantly after the initiation of public health interventions during the Covid-19 pandemic. Chaiyachati et al. demonstrated decreased volumes in a US PED [1], and recent studies in other countries support this observation [2-6]. An understanding of patient and visit characteristics during pandemics can ensure PED preparedness during high-volume surges or atypical low-volumes. The aim of this study was to describe PED visit characteristics, with an emphasis on throughput, during the COVID-19 pandemic compared with a historical period. (Source: The Ame...
Source: The American Journal of Emergency Medicine - September 27, 2020 Category: Emergency Medicine Authors: Laura Even, Matthew J. Lipshaw, Paria M. Wilson, Preston Dean, Benjamin T. Kerrey, Adam A. Vukovic Source Type: research